The goals of this project are to develop patient-reported measures of perceived bias in their encounters with health care professionals, to examine the psychometric properties of these measures, and to explore the effect of perceptions of bias and discrimination on relations between doctors and patients, including trust and satisfaction with health care. This project will assess current measures of perceived bias and develop questions that can be used to elicit patient perceptions of ethnic or racial bias in medical care. The improved questions to measure patient perceptions of bias will be specific to medical care, applicable to any health condition, and appropriate for any ethnic group. Using a series of focused group interviews and two rounds of cognitive interviews with African Americans, Latinos, and non-Hispanic whites, we will assess patients' experiences with bias, examine their understanding of survey questions, explore how they respond to questions about bias, and develop and revise questions, as necessary. We will field a pilot test of a survey based on the CAHPS Ambulatory Care survey that includes a supplemental module of questions about bias in medical care. The pilot test will be conducted in two federally-funded health centers that serve ethnically diverse populations. We will assess the psychometric properties of questions about bias, including reliability, content validity, and construct validity. Employing a conceptual model that embeds perceived bias as an intervening influence on the patient-physician relationship, we will test the hypothesis that patients reporting experiences of bias have less trust in health care professionals and subsequently less adherence to medical advice and poorer self management of disease. Survey tools developed in this project may be used to improve communication between patients and health care professionals. A short module of survey questions to elicit patient reports of bias in medical care will be used to assess the association among perceived bias, trust in health professionals, participatory decision making, and adherence to recommended treatment of diabetes. These new tools to measure bias in medical care can be used to monitor change's in patient perceptions after interventions to train and educate both patients and health professionals. Disparities in health are a severe public health problem in the United States. Compared with non-Hispanic whites, diabetes-related death rates are consistently higher for African American and Latinos. Patients' perception of bias is a likely barrier to developing effective relations between patients and health professionals. This project will create new methods to collect information about patient reports of bias in medical care. [unreadable] [unreadable] [unreadable]